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Farm AMOved,OMB Nt>.20E-0439 <br /> P WTilor, d.Manifest rac n9 umber <br /> Please print or type.(Form desi nsd lar use as elife 12 11th)iyp+� 2. Pay&1 of 3.En`*Q tcl+Response Plwna 0 8 3 p 9 4 J J K <br /> ,Generaior ID tiumbar <br /> UNIFORM HAZARDOUS 1, (800)X124-9300 <br /> WASTE MANIFEST CAL 0 0 0 3 6 8 6 9 3 Generator s Aldress(if dillErent(hun ma4ing address} <br /> 5.Ganeraloz s flame and Mwlln9 AcWmss <br /> IMPERIALTRUG'k WISH AND REPAIR JAZZ GROUP f <br /> 2142 W.YOSEMITF AVE JAZZ GROUP INC <br /> MANTECA CA 95337 <br /> Generators Nhane: 20 <br /> e.Transporter 1 Company Name CAD 0 2 8 2 7 7036 <br /> WORLD OIL ENVIRONMENTAL SERVICES U.S.EPA ID Number <br /> 7.Transporlvr 2 Company Name C AR 0 0 017 5 4 2 7_ <br /> WORLDWIDE RECOVFRYSYSTEM INC, U.S.EPA IDNUrMsr <br /> a.Designated Facility?Jame end Site Address <br /> YES MANAGEMENT. INC, <br /> 6.500 US HIGHWAY 95AZF35365 A Z R O O 0 5 2114 6 <br /> YUMA <br /> F,Ii t a Phons: 928)344-9 10.Containers 51,TOW 12,Unit i3,Waste Codes <br /> U.S.DOT tlea0riOM(indudin9 PMW Shippktg Name.Hazard Class,l9 Number, No. Type Ouantily WWd. <br /> 9b. <br /> 9s. <br /> HM uad Packing Group(f any)) 382 <br /> D M1.NON-RORA HAZARDOUS WASTE,SOLID(PAPER FILFEhS) � P <br /> O I v <br /> ? 2. <br /> w <br /> 3. <br /> 4. <br /> > `j �' <br /> 14.S poclal HandEng Instrucliana and Additional Infom)a <br /> EMERGENCY CONTACT :CHEMTREG 1.800-424-9300 WOES i ERt�ti;VAI,CERES CS NAERG��9S1:371 * PROFILE 961: <br /> 162623NRSIMP072 PAPER FILTERS ' ':APPROPRIATE PPE EWPMENT � °��2J� <br /> 15. GENERATAR'310FFER4H'8 CER(4FICATIDN; !freretry declare that the m+ttenta of ihVs wnsigmm�rA areliy and'aocvtalely dasenlwd above by the proper ehipplr�g name,and ars daasy4ed,Rackaged, <br /> marked and!at aledlplacarded,and are In all rsspecls in proper 00mftfon Por transpo+t a=ming to ao att�ia Intetttaticr xl and nalsonal govemmantal f a9+tls tW.N expott lihi nant and I am the Primary <br /> nrnent wnform to lerms of tho abdred f?PAAckr�+siad9meRt of Gensenl <br /> Enpartw,i cerllry mal the c7nianta o}kbJn cor>s3g wwrtkor at d l am A email 9 generawr)la true. <br /> I comfy that the waste minlietz"Ork slAtome+tl idenll%d in 40 C 21(a)(t1 t am a terga tluanUy g ) l)I 4tanth Day Yoar <br /> lure G{� <br /> Gan tor'albftarors Pr{ntadlTyped Name �_JJ <br /> 16.Iniotnetional Shipments ImPod to U.S. ❑Frgcrt hom U•5• Pari or enlrylwdl:. <br /> Date leavN U,S.: <br /> Traftsporler signatura(for nxparts Only): <br /> 17.Tmnzporlec Ackrwwieclgrnentaf R"pk of H1alfKtals rhon[h Day Ye. <br /> 5!gnaturB <br /> 1-ranspo PrintoilT Nam }�e l ` <br /> C] 4 Month Day Year <br /> 4 Tra frarter 2 f dMedffy*-NA 51gnaNr ) {) <br /> t- <br /> 10 I3ESuePancY <br /> Rene ❑Aanlai Relaciias ❑Ful!Rejection <br /> IW.DiscrepancyJndicaliwSpace � QuflniityTypo <br /> Manifest Rofaronce Nymbar. <br /> U.S.EPA 10 Number <br /> 18b-Alb? Ali)Faal'rty(orGertefator) <br /> u4 FaCflity's Phone; Month Day Year <br /> w 1130.Signalure of Alemate FAcl y or Ganemlor) <br /> Q <br /> 7 <br /> i g,Hazarda+s Waste Repot ManKernent W tod Codes(+.e.,ardes far hazardous waste troatrrRnt.dssposal,and reryding syskam5 4. <br /> LU 2 3. <br /> a t. <br /> 20.Dsagnated Fatuity4'�'ra tar Car4AcaUnn of rscolpl of hazardous materials covered by the man�it�tumcept as rrcted in hent 10a th Day ear <br /> i'rinl yped Mame <br /> EPA Form 87ff0.22(Rev. 5) rsvlous edit7ons are o Ie a. IJESI TE FAC Ll TO DESTINATION STATE (IF REQUIRE[ <br />